Reading the Numbers

Last week’s report about the declining abortion rate in the United States was potentially good news for everyone, especially, one would think, for right-to-life groups. Most of them, though, weren’t cheering. A statement from Americans United for Life called the report “an abortion industry propaganda piece short on data and long on strained conclusions.” One problem was that the groups didn’t like the messenger. The report, which showed that between 2008 and 2011 the rate of abortions had fallen to its lowest level since 1973, came from the Guttmacher Institute. Guttmacher produces scrupulous research on reproductive health; it also supports abortion rights. But the bigger problem was the message itself, because the report made a persuasive case that the right-to-life movement cannot take credit for the decline in abortions. Since 2008, states have enacted more than a hundred laws related to abortion, most aimed at limiting access to the procedure. The researchers, however, concluded that the new laws, with few exceptions, had had little impact on the number of abortions. Instead, much of the decline is probably attributable to more effective contraception, some of it available through the federal funding—“Uncle Sugar,” in Mike Huckabee’s creepy coinage—that Republicans like to rail against. Right-to-lifers could be promoting contraception and touting its success in averting unwanted pregnancies, but that doesn’t seem to be news that they want to hear, let alone spread.

In fact, nobody can say for sure why the rate is falling. But the report’s authors, Rachel K. Jones and Jenna Jerman, point to some key indicators. For one thing, there was a notable drop in the rates in several states, such as California, New York, and New Jersey, that had not enacted new restrictions. Indeed, rates dropped in all regions of the country, although the new laws are concentrated primarily in the Midwest and the South. Moreover, most of the restrictive laws were passed in 2011, and the decline was already under way in 2008. Finally, and critically, the decrease in abortions has been accompanied by a decrease in the birth rate, suggesting not that fewer women are choosing to terminate pregnancies but that fewer women are getting pregnant in the first place.

One reason for that trend might be economic—pregnancy rates and birth rates tend to fall when times are tough. But a shift toward more effective birth control does seem to have played a role. Between 2002 and 2009, the proportion of contraceptive users who relied on long-acting reversible contraceptives like IUDs and implants rose from two per cent to nine per cent. That might not sound like much, but, because LARC methods (unlike condoms or the Pill) are more than ninety-nine per cent effective, even a relatively small uptick in usage can have an impact. Particularly noteworthy was the increase in the number of low-income and poor women who use long-acting methods provided by publicly funded birth-control services. According to the report, between 2006 and 2010 “the estimated number of unintended pregnancies averted by federally funded family-planning programs” rose from 1.9 million to 2.2 million.

Nonetheless, the new laws do place additional burdens on women seeking abortions, and, perhaps more important, they may also be erecting obstacles to a consensus position on abortion—one that most Americans could abide. For reasons both moral and practical, most Americans think that if an abortion is to be performed it should be done early in the pregnancy. Yet many of the laws that right-to-life groups have pressed for in recent years have tended to produce the opposite effect, resulting in later abortions. Consider the case of medical abortions, induced by the drug mifepristone, the so-called abortion pill. The Guttmacher report shows that, between 2008 and 2011, there was a striking increase in the percentage of such procedures—in 2011, they accounted for twenty-three per cent (up from seventeen per cent) of all non-hospital abortions—even as the over-all rate declined. By definition, these are early abortions: they are performed before nine weeks’ gestation. (Unlike surgical abortions, they can be done almost as soon as a woman receives a positive pregnancy test.) From the public-health, reproductive-choice, and moral-comfort points of view, an increase in the percentage of abortions performed this way is beneficial.

Yet the latest vogue in anti-abortion legislation is to ban medical abortions. One approach has been to short-circuit programs that allow mifepristone to be prescribed through telemedicine. A program started in Iowa, in 2008, allowed a woman to receive ultrasounds and talk to a counsellor at a satellite clinic, and then video-conference with a doctor in another location. The doctor could remotely unlock a drawer in the clinic and the necessary medication was dispensed to the woman. After the program began, women seeking abortions in Iowa tended to do so earlier; nevertheless, the over-all abortion rate in the state declined. The program’s safety record and women’s reported satisfaction with it were solid. (It was especially helpful in rural areas.) But in 2010 Iowa elected an anti-choice Republican governor, who appointed new members to the state medical board, and it subsequently ended the program. A judge stayed the ban in November, and the matter is now being litigated. Meanwhile, legislatures in fourteen other states have prohibited the use of telemedicine for medical abortion—“Webcam abortion,” as opponents call it—even though the system hasn’t even been tried on any significant scale in those states.

All this brings to mind the bizarre inability of certain prominent Republicans to understand the importance of contraception in our society. Making it more difficult for women to get an abortion early in an unintended pregnancy—or to prevent an unintended pregnancy in the first place—makes their lives harder. Yet Mike Huckabee and Rand Paul have been on a tear recently, insisting that focussing on reproductive rights patronizes women. Unlike Democrats, Huckabee says, Republicans want women to be “something other than victims of their gender,” who are “helpless without Uncle Sugar” to “control their libido or their reproductive system.” It shouldn’t be necessary to say it again, but a woman’s ability to exert control over her reproductive system is at the heart of her ability to control her destiny in many other ways as well. Besides, when conservatives attack the contraception mandate in the Affordable Care Act, or federally funded family-planning programs, they are working against the forces that are rendering abortion less common. Undermining contraception and early abortion sabotages the future that most people want, one that expresses both their values and their common sense: fewer unintended pregnancies and fewer abortions, too. ♦

Margaret Talbot is a staff writer and the author of “The Entertainer.”